​The 12 Phases Emotional Algorithm: The Road to, Through & Back From Trauma (An Excerpt From "Why Cope When You Can Heal?") by Mark Goulston

A traumatic event can shatter your sense of safety and security, and create lasting harm. This is especially true for health-care workers, many of whom are experiencing symptoms of post-traumatic stress disorder (PTSD) after nearly a year of working on the pandemic frontlines.

The 12 Phases Emotional Algorithm is a framework that describes the processes that typically occur in your psyche when a traumatic event takes place. It applies not only to health-care providers but to anyone experiencing intense trauma.

Phases one through 10 describe everything that occurs from the time trauma occurs to the time when PTSD develops. Phases 11 and 12 highlight the journey to recovery and how to get past it. The entire algorithm is the basis for Dr. Goulston’s Surgical Empathy technique. 

1. Trauma: This is an event of vast proportions that shocks, distresses and overwhelms you, which temporarily cause you to fight, flee or freeze mentally and physically.
2. Horror: You see or experience horrific things without having the opportunity to fully feel the horror. This includes shock, surprise and the inability to comprehend what’s happening.
3. Terror: Your primary focus becomes the survival of your body and psyche.
4. Fragile: You may feel like a windshield in a car that has become cracked, yet not broken. You may feel that the next hit will cause you to “shatter” and never come back. (What is shattered is your prior belief system about your safety and security.)
5. Overriding Panic: Being duty bound by your work causes you to clamp down on any feelings to avoid becoming overwhelmed and freezing as you see others hurting and as you feel your own powerlessness.
6. Suppressed Thoughts: You consciously push whatever you’re tempted to think about out of your conscious mind in order to focus.
7. Repressed Feelings: For the sake of survival, your mind pushes the feelings further down into your unconscious and away from your conscious mind.
8. Focus and Function: You focus and carry on. This is what you now do to live up to responsibilities because there is a higher need at the moment to lead, organize and unify. You can deal with feelings later.
9. Danger Has Passed: When an acute threat has passed, you may internally relax your guard that has protected you from experiencing intolerable feelings. With that internal guard lowered, the unfelt feelings you repressed and pushed away while the trauma was happening can resurface. Your mind may say I’m safe but your body says, You’re lying.
10. PTSD: PTSD shows up in four major ways: intrusive thoughts, avoidance, negative thoughts, and hyperarousal. You may experience nightmares, anger, irritability, anxiety, hypervigilance and may be easily startled by loud noises or sudden movement. You may withdraw from social activities, become increasingly isolated and appear depressed.
11. Disabled or Recovered: You either become further impaired by the trauma you experienced or begin a journey to healing.
12. Healed: You fully reexperience the trauma, along with the full spectrum of emotions and feelings the trauma created, and regain the capacity to feel peace and joy at last.

Though it can be upsetting or overwhelming to read through the 12 phases that lead to, through and beyond trauma, do not despair. The algorithm is a powerful key to recovery. When you empathetically revisit these phases one at a time and fully confront your feelings and thoughts at each, the process can help you heal.

Excerpted from Why Cope When You Can Heal? How Healthcare Heroes of COVID-19 Can Recover From PTSD (Harper Horizon, December 2020, ISBN: 978-0-7852-4462-2, $17.99) by Mark Goulston, MD and Diana Hendel, PharmD.

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